In this study, we examine the long-term effect of early treatment with the angiotensin receptor blocker (ARB) losartan on progression of kidney disease in American Indians with type 2 diabetes. wrote the draft of the report and designed the clinical trial. It also improves your survival if you're taking it … Burnier M, Rutschmann B, Nussberger J, Versaggi J, Shahinfar S, Waeber B, Brunner HR. Epub 2013 Sep 24. Enter multiple addresses on separate lines or separate them with commas. Losartan is also used to slow long-term kidney damage in people with type 2 diabetes who also have high blood pressure. Reliance on renal function changes or on surrogate markers such as albuminuria may not be sufficient to adequately evaluate renoprotection in early diabetic kidney disease even after many years of follow-up. Ultimately, in this underpowered study, it is difficult to disentangle whether our findings indicate no benefit of early RAS blockade on diabetic kidney disease or whether any benefit that may be present, particularly if small, was masked by the use of RAS inhibitors in the placebo group. To avoid the bias (informative censoring) that occurs when loss to follow-up is related to the study outcome, we used linear imputation to estimate the date of onset of the study outcomes (GFR and albuminuria). Losartan which contains potassium can help kidney disease patients lower their high blood pressure effectively, which will be good for kidney disease patients. Kirsty, Losartan is known to cause an increase in creatinine but as long as it is a small increase, the consultants accept this as a side effect of the medication and not significant as a problem with your kidney function as such. No potential conflicts of interest relevant to this article were reported. This medication has the ability to lower the possible risk of a stroke in people suffering from any heart condition. STUDY DESIGN: A total of 35 adult male Wistar rats were divided into control, diabetic, diabetic gliclazide, diabetic resveratrol, and diabetic losartan groups. The common side effects include dizziness, low blood pressure, skin rashes, diarrhea and migraine. R.G.N. Clinical trial reg. In the microalbuminuria group, the HR for developing macroalbuminuria was 0.68 (95% CI 0.40–1.18). The study is created by eHealthMe based on reports of 28,684 people who have side effects when taking Losartan potassium from the FDA, and is updated regularly. Smith MC, Barrows S, Meibohm A, Shahinfar S, Simpson RL, Weigel K, Dunn MJ. Adjustment for age, sex, diabetes duration, MAP, GFR, and ACR did not significantly alter our results (HR 0.88 [95% CI 0.52–1.48]). Using losartan with NSAIDs raises your risk of kidney damage. Renal effects of angiotensin II receptor blockade and angiotensin-converting enzyme inhibition in healthy subjects. This approach permitted us to estimate whether a participant who missed scheduled visits and did not reach the primary GFR outcome by their last examination would have done so if they had remained under observation. However, exposure to antihypertensive drugs in the placebo group during the clinical trial was limited to 20% of the total person-time. More information is available at http://www.diabetesjournals.org/content/license. 2013 Mar;61(3):701-6. doi: 10.1161/HYPERTENSIONAHA.111.00377. Your risk may be higher if: you have poor kidney function; are a senior; take a water pill; are dehydrated We examined the renal hemodynamic modifications induced by a selective angiotensin II (AII) AT1 receptor antagonist, losartan, in 10 patients with essential hypertension. The present analysis combines data collected during the clinical trial and data collected at annual research examinations that continued for a maximum of 12 years posttrial. Losartan may be used for the treatment of high blood pressure or certain types of kidney disease. In this single-blind study, renal hemodynamic parameters were determined twice (patients were their own controls) first after a 15-day single-blind placebo run-in period and again after a 1-month losartan period. A borderline statistically significant interaction was found between treatment group and baseline albuminuria status when examining annual mean HbA1c (P = 0.05), with losartan treatment being associated with higher HbA1c in those with normoalbuminuria but lower HbA1c in those with microalbuminuria. The dosage of losartan was 50 mg/day. Annual mean MAP and HbA1c are shown by treatment group assignment in Fig. Death occurred in 58 participants (32 were randomized to placebo and 26 to losartan) and in 11 was preceded by ESRD. RAS inhibitors acutely lower GFR during the first 1–3 months of treatment, but may chronically slow the rate of GFR decline. Impact of irbesartan, an angiotensin receptor blocker, on uric acid level and oxidative stress in high-risk hypertension patients. In people with high blood pressure, the most common side effects of losartan include dizziness, stuffy nose, and back pain. This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc16-0795/-/DC1. Other treatment was provided by the primary care physician. performed the statistical analysis. Angiotensin II, independent of plasma renin activity, contributes to the hypertension of autonomic failure. A similar reduction in incidence and progression of nephropathy with prior tight glycemic control was reported in type 2 diabetes by the UK Prospective Diabetes Study (UKPDS), many years after the conclusion of the clinical trial itself (3). An extended benefit of early intensive glycemic control on microvascular complications even after subsequent return to conventional glycemic control is well described. RESEARCH DESIGN AND METHODS We conducted a 6-year clinical trial in 169 American Indians with type 2 diabetes and urine albumin/creatinine ratio <300 mg/g; 84 participants were randomly assigned to receive losartan and 85 to placebo. Upon trial completion, the study drug was no longer supplied. Blocking angiotensin II widens (dilates) blood vessels which lowers blood pressure. For outcomes determined independently of the annual research examinations (ESRD and death), follow-up time accumulated from enrollment into the trial until the date of the event or 31 December 2015, whichever came first. Clipboard, Search History, and several other advanced features are temporarily unavailable. It works by blocking a substance in the body that causes blood vessels to tighten. NRK-52E cells were incubated with CaOx crystals, and glyoxylic acid-induced hyperoxaluric r… Would you like email updates of new search results? 1995 Dec;8(12 Pt 1):1177-83. doi: 10.1016/0895-7061(95)00361-4. In contrast, mesangial fractional volume at the end of the trial was lower in participants with microalbuminuria who were assigned to losartan than in those who were assigned to placebo (7). RESEARCH DESIGN AND METHODS We conducted a 6-year clinical trial in 169 American Indians with type 2 diabetes and urine albumin/creatinine ratio <300 mg/g; 84 participants were randomly assigned to receive losartan and 85 to placebo. Subjects who did not participate in the posttrial follow-up did not differ from those who did in terms of age, sex, diabetes duration, BMI, blood pressure, HbA1c, GFR, and ACR at baseline. Moreover, ABP monitoring has been found to be more closely related to target organ damage 20, 21 and to cardiovascular mortality than clinic BP 22, 23. Chida R, Hisauchi I, Toyoda S, Kikuchi M, Komatsu T, Hori Y, Nakahara S, Sakai Y, Inoue T, Taguchi I. Hypertens Res. R.L.H., W.C.K., and P.H.B. Twenty-six participants progressed to ESRD during follow-up (11 were randomized to placebo and 15 to losartan). ... All of the components of the RA system have been reported to be present in the kidney, and it has been suggested that intrarenal Ang II levels can be regulated independently of the circulating RA system. Data on other antihypertensive drugs received during and after the trial were ascertained by self-report. Among the 51 participants with microalbuminuria who had a kidney biopsy at the end of the clinical trial, those who received losartan during the 6-year trial had lower mesangial fractional volume and higher filtration surface area than those who received a placebo. Rather than occurrence of any modification in filtration fraction (FF), a significant decrease in microalbuminuria was evident (57 +/- 77 vs. 40 +/- 59 mg/24 h, p < 0.05). The increase in renal uric clearance accounted for the significant decrease in serum uric acid (195 +/- 49 vs. 183 +/- 43 microM; p < 0.05). However, during the subsequent follow-up, adherence to annual research examinations declined, and 15 participants progressed to ESRD without documentation of reaching the primary GFR outcome at a research examination. I … The effect of losartan on the primary GFR outcome was then reanalyzed for the entire study period, including the clinical trial and posttrial follow-up. Renal effects of angiotensin I-receptor blockade and angiotensin convertase inhibition in man. NCI CPTC Antibody Characterization Program. Times to outcomes were compared by treatment group using Kaplan-Meier survival curves and the log-rank test. HRs (95% CI) for the effect of early treatment with losartan on long-term outcomes in each baseline albuminuria stratum and for the combined strata. Kidney stones is found among people who take Losartan potassium, especially for people who are male, 60+ old, have been taking the drug for 1 - 6 months. Standards of care for people with diabetic kidney disease were evolving, and this modification was required by the ethics committee overseeing the study. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. No interaction was found between treatment assignment and albuminuria group (P = 0.11). Of the 170 participants randomized in the clinical trial, one had no follow-up measurements and was excluded from analysis (7). Alternative end points, such as structural end points from kidney biopsies, may be required to demonstrate renoprotection in early diabetic kidney disease. The current consensus, based on several clinical trials, is that RAS inhibition provides no benefit for primary prevention in normoalbuminuric, normotensive patients with diabetes and may actually lead to harm (18). NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. 56 (1999), pp. At baseline, 92 participants had normoalbuminuria (albumin/creatinine ratio [ACR] <30 mg/g) and 78 had microalbuminuria (ACR 30 to <300 mg/g). We had expected that the early structural differences seen on kidney biopsy at the end of the clinical trial might lead to an extended functional benefit of early treatment in our cohort (7). Increase of ROS and NADPH oxidase gives rise to inflammation and injury of renal tubular cells, which promotes CaOx stone formation. To account for the acute effects of initiating treatment with RAS inhibitors, GFR measured at each research examination, conducted either during or after the clinical trial at which the participant was treated with a RAS inhibitor, was adjusted upward by 3.75% as described previously (9). However, because a significant interaction was found during the clinical trial (P = 0.02), and the risk of macroalbuminuria continued to be in the opposite direction by albuminuria group, the HR for macroalbuminuria was examined separately in these groups. G.D.F. Salt-dependent renal effects of an angiotensin II antagonist in healthy subjects. Furthermore, the risk of kidney disease progressing to ESRD in this population may differ from that in other populations because of poor glycemic control and because of the lower risk of competing cardiovascular deaths prior to the onset of renal replacement therapy (25). Liver damage, known as fibrosis, is caused by the unwanted accumulation of excess fibrous connective tissue which is produced and maintained by a specialised cell, the liver myofibroblast. The same approach was used to compute follow-up time and event status for the albuminuria outcome, assuming that development of ESRD also reflected progression to macroalbuminuria. Am J Hypertens.  |  There was no interaction between treatment assignment and albuminuria group in predicting death (P = 0.22) or the combined end point of ESRD or death (P = 0.08). Mol Biol Rep. 2013 Nov;40(11):6295-301. doi: 10.1007/s11033-013-2742-9. The HR for the primary GFR outcome in those receiving losartan versus placebo was 0.72 (95% CI 0.44–1.18). Losartan is used to treat high blood pressure (hypertension) in adults and children who are at least 6 years old. Sign In to Email Alerts with your Email Address. Characteristics at the last clinical trial visit for the 149 participants who remained posttrial were similar between treatment groups (Table 1). Blood pressure was measured while the participant was seated. The cumulative incidence for the primary GFR outcome and the serial HRs are presented in Fig. During posttrial follow-up, 85% of the participants randomized to losartan and 86% to placebo received RAS inhibitors; 6% of those randomized to losartan and 6% to placebo received ARBs alone, 54% of those randomized to losartan and 52% to placebo received ACE inhibitors alone, and 25% of those randomized to losartan and 28% to placebo received both. All analyses were based on intention-to-treat principles. The Different Therapeutic Choices with ARBs. 2016 Aug;16(4):255-266. doi: 10.1007/s40256-016-0165-4. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. Subsequent follow-up was considered posttrial follow-up. 2. Consistent with previous findings in antihypertensive drug trials in type 2 diabetes (12–14,19), risk of all-cause mortality in our study did not differ between those randomized to losartan or placebo. Author Contributions. RESULTS After completion of the clinical trial, treatment with renin-angiotensin system inhibitors was equivalent in both groups. 1,788 were here. However, as all the western medicines can cause side effects to people and losartan can also cause side effects to people. OBJECTIVE To determine whether early administration of losartan slows progression of diabetic kidney disease over an extended period. Although cozaar is harmful for kidney to some extent, it does not mean all the kidney disease patients should stay far away from this medication. Losartan is used to treat high blood pressure (hypertension). In individuals with type 2 diabetes taking losartan to manage kidney problems, the most common side effects include chest pain, diarrhea, high blood potassium, low blood pressure, low blood sugar, and tiredness. 2014 May 3;6:79-86. doi: 10.2147/CPAA.S61462. 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